Author(s): *Richard P. Evans, Chou Eyberg, B.S., B.S.Ch.E., M.S. Dan Morse, B.S.Ch.E., M.S. andLaurie Behr; University of Arkansas for Medical Sciences, Little Rock, AR
Title: Characteristics of Surgical Skin Preparation Solutions on Incise Skin Drape Adhesion and Skin Exposure
Purpose: To evaluate the effect of two preoperative skin prep solutions on the occlusive drape adhesion of thefive incise drapes and one edge-adhesive surgical drape. Measurement of resistance to mechanical drape lift-off is presented.
Methods: The backs of 36 healthy volunteers were skin prepped with commercially available iodinepovacrylexalcohol (I-PA) solution or chlorhexidine gluconate alcohol (CGA) solution according to manufacturers instructions. Five incise and one edge-adhesive surgical drapes were applied to each dried skin prepped area on each subject... Each subjects back was divided into four 4" X 5" area. Two commercially available surgical skin preps were applied to the subject's back. Six commercially available surgical drapes were applied to the prepped areas. Each area was randomized for prep and drape used During a surgical procedure, incise drapes may be exposed to copious amounts of blood and irrigation fluid. To simulate this fluid challenge each area was then covered with room temperature saline-soaked gauze for 30 minutes. Drape samples were then mechanically removed from the skin (peeled) at a 90 degree angle at 12 in/min using an adhesion peel load-cell Model 308 Pull-Peel Tester, which measured force as each solution-drape sample was removed mechanically. The measured peel load of each sample is directly proportional to solution-drape adhesion.
Results: Each I-PA solution-drape had statistically significantly higher skin adhesion (peel-load) than CGAsolutiondrapes (p < 0.0001.). The average skin adhesion for the IP-A was nearly twice that of the CGA. No adverse events occurred.
Discussion: Occlusive surgical incise drapes are effective when adhered securely to patient skin if it provides mechanical isolation of skin flora and decreases wound contamination from the skin. Adhesion is important at the wound edge where the skin and incise drape is contiguous with the wound. Drape lift at the wound edge has been associated with a 6-fold increase in surgical site infection. This study documents incise drape adhesion is dependent upon the type of skin prepping solution used with incise drapes available. Statistically significantly greater adhesion characteristics with the I-PA solution were observed with all six drape materials. This suggests that drape lift from the skin and subsequent wound contamination by skin flora is significantly affected by the type of skin prep solution employed with available incise drapes.